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Push for price transparency reveals challenge of estimating costs

Insurers' tools sometimes have limited ability to accurately gauge prices
November 30, 2015 | By
Tools

Despite the push for consumers to shop around in order to save money on their health plans in 2016, some have expressed frustration with the current price transparency tools provided by insurers, according to NPR.

The need for transparency is greater than ever, as the considerable cost variation for medical procedures can have negative financial consequences for both individuals and employers.

But one issue with the current tools available, according to NPR, is price calculator accuracy. Price calculators are becoming more and more popular, as patients take on a bigger share of the cost of medical care. Outside companies are developing the calculators, and today, most insurers offer them to customers when they are trying to price out plans, the article says.

Yet there are a lot of variations in the information provided to patients about various services. Many of these tools have limits, since it is difficult to predict what a physician will actually do in an exam, during treatment, or during an office visit, or how the doctor will bill for it, according to NPR. Since billing is so complex, it is almost impossible for online calculators to be completely accurate--as one couple found when trying to use UnitedHealth's cost estimator tool.

"There are 8,000 procedure codes, tens of thousands of diagnostic codes, a million different providers, and hundreds of insurance companies," David Newman, director of the nonprofit Health Care Cost Institute, said in the article. "Calculators are often based on one specific procedure, so they may not reflect all that happens and is billed for during a visit. So he thinks the current tools available may be as good as it's going to get.

Despite the challenges associated with price transparency tools, there are many benefits to using them. One recent study revealed that states with transparency websites saw a 7 percent decrease in prices for common, elective medical procedures. Also, according to NPR, employers are beginning to demand these tools for their employees.

To learn more:
- read the NPR article

Related Articles:
How insurers can make transparency tools more consumer-friendly
AHIP: How insurers can improve price transparency tools
HHS touts consumer education amid insurers' ACA concerns

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